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The spinal cord is a thick nerve that runs down the neck and back; it is protected by bones called vertebrae. If the spinal cord is injured, this can lead to paralysis. Since the vertebrae protect the spinal cord, it is generally difficult to cause such an injury. Note that only an x-ray can conclusively determine if a spinal injury exists. If a spinal injury is suspected, the victim must be treated as though one does exist.

Life over limb: Immobilize the spine as best as you can, but Airway, Breathing and Circulation take priority.

The victim should not be moved unless absolutely necessary. Without moving the victim, check if the victim is breathing. If they are not, CPR must be initiated; the victim must be rolled while attempting to minimize movement of the spine. If the victim is breathing, immobilize their spine in the position found. The easiest way to immobilize the spine in the position found is sandbagging. Despite the name, it doesn't necessarily require bags of sand. Simply pack towels, clothing, bags of sand etc. around the victim's head such that it is immobilized. Be sure to leave their face accessible, since you'll need to monitor their breathing.

If you must roll the victim over to begin CPR, take great care to keep their spine immobilized. You may want to recruit bystanders to help you. Hands-on training is the only way to learn the various techniques which are appropriate for use in this situation.

Many spinal injuries are the result of a dive into shallow water. Lifeguards and lifesavers receive specialized training to manage spinal injuries in the water. Such hands-on training is the only way to learn the various techniques which are appropriate for use in such situations. If you see a victim in the water and did not witness what happened to the victim or are unsure if the victim has a spinal injury, immediately get the attention of a lifeguard or other trained responder.